Brain teaser

Specialist pieces together puzzle of each patient to treat autism

Specialist pieces together puzzle of each patient to treat autism

November 08, 2006|DAVID RUMBACH Tribune Staff Writer

SOUTH BEND -- When Dr. William Mize chats with new patients for the first time, he has them sit at a little table and work on puzzles. The youngsters piece together a picture or reassemble wooden blocks into a cube. Mize meanwhile mulls his own brainteaser -- them. His job is to fit their symptoms into a coherent picture and come up with a diagnosis that will guide their treatment and help them grow. "I think of them as my puzzles,'' he said. Mize is the area's only board-certified developmental-behavioral pediatrician and one of only five or so in all of Indiana. He's been practicing in South Bend for a little more than a year. Memorial Hospital, aided by a monetary gift from a local family, recruited him from the University of Illinois School of Medicine, where he taught pediatrics. The hospital's goal was to help parents worried that their children are not developing normally and might have autism or a related disorder. There's urgency in that situation because treatments work best if started at an early age. Mize began taking patients in September 2005 at the Regional Center for Children's Services on Michigan Street, just north of Memorial. He's seen more than 200 children since the opening. "We've been growing at a steady clip ever since.'' he said. "The number of children with autistic spectrum disorders was huge at first. Now it's more of a mix of autism and complex ADHD.'' His staff includes three nurses, a social worker and a nutritionist. They assist him in making a diagnosis, and then the staff works as a team to formulate a treatment plan. The plan almost always includes recommendations for alternative treatments, including therapeutic horse riding, special piano lessons and even martial arts. "My job is to provide accurate diagnosis and to point families toward a range of therapies that might help them,'' he said. A puzzle named Janie, 5 One of the first puzzles Mize pondered in South Bend was Janie, the daughter of Eric Robinson and Teresa Brito-Robinson of South Bend. They took her to the new clinic in October 2005, about a month after it opened. Like many of the parents of his patients, the Robinsons had already received a diagnosis through the South Bend Community School Corp. The school corporation's evaluation entails a three-day thorough assessment by a trained staff, including a school psychologist, according to Kristin Harges, special education supervisor. But the Robinsons also wanted a physician specialist to weigh in on their daughter's condition and care. They were on a waiting list for appointments in Chicago and Indianapolis. "Then we heard that Dr. Mize had come to town,'' Teresa said. Mize confirmed the school corporation's diagnosis of severe autism combined with high intelligence. What he's added to her care are medical and nutritional dimensions that would not otherwise be available. Janie, a preschooler at Lincoln Primary Center, is taking vitamins, supplements of Omega-3 fatty acids (for brain development) and melatonin (to aid sleep). She also takes a stimulant for attention deficit and, surprisingly, a new medication called Namenda that was developed for people with Alzheimer's. The Robinsons believe the treatments have helped their daughter sleep better, stay calmer and even learn more. "She's had spurts of learning,'' Eric said. "She plateaus for a while and then all of sudden starts to learn new things.'' Waiting list growing The waiting period is three to four months at Mize's clinic. But parents of new patients need at least some of that time to compile the voluminous information that Mize requires for diagnosis. That includes records of previous tests and treatments and several very long questionnaires parents fill out to give a detailed picture of their child's behavior, symptoms and family history. It can be tricky to diagnose autism, which is defined by a set of features related to problems with socializing, communicating and learning, Mize said. There's a lot of overlap among symptoms seen in children with different developmental disorders -- as well as overlap with normal children. "The truth is a great many children who are normal have a feature of the autistic spectrum,'' Mize said. "The intensity has to be sufficient and the range has to be sufficient to warrant a diagnosis.'' Mize said one of his goals is to tease out the secondary illnesses that children with developmental delays tend to have and which are important pieces of the puzzle. Those include both emotional problems and learning disabilities. Developmental pediatricians are a rare breed, according to the American Board of Medical Specialties. The board's Web site lists only four of them practicing in Indiana, eight in Michigan and nine in Illinois (Mize is still included among the Illinois practitioners). They start out being trained as general pediatricians and then go on to receive extra training in the subspecialty of developmental and behavioral medicine. To claim the title "board-certified'' requires passing a rigorous exam. Mize said he's always considered childhood development to be the most "interesting and fulfilling'' part of pediatrics. But the origins of his passion may go back much further than medical school. When he was in first grade in Houston in the 1950s, his teacher always made sure that someone helped a girl with multiple impairments get to the playground. Not just to the sidewalk but out into the sunshine among the other children. More often than not, the one pushing the girl's wheelchair into the whirl of shouting, playing classmates was William Mize. "The teacher stood up for the girl,'' Mize recalls. "She was upset that the other teachers left her on the sidelines. I guess she was an early advocate.'' Research at Notre Dame Besides heading the clinic, Mize also has a research position in the psychology department at the University of Notre Dame. The post was part of the package that lured him here from the University of Illinois. Mize said he hopes to explore the effectiveness of low doses of antidepressants called selective serotonin reuptake inhibitors in treating autism. The ideas is to study those drugs, which include Prozac and Celexa, in conjunction with a rigorous psychological approach called applied behavioral analysis. The practice of using antidepressants to treat the symptoms of autism is new to this area -- and not fully embraced by all local families with autistic children. Mize and other specialists use Prozac in autistic children because they have found that it sometimes improves brain function and boosts their learning. "It's new around here but not in other places,'' he said. "It's not a new idea.'' While medical treatment for autism is not new, it's not proven to be effective and not fully researched. Mize wants to help fill in some of the gaps in collaboration with the psychologists at ND. In particular, he said he wants to see if SSRIs enhance applied behavioral analysis, a long-standing and well-established psychological treatment for autism. "It's hard to get to the truth of these questions,'' he said. "That's why we need research.'' The Robinsons are one family that is not averse to the idea of pharmaceutical treatment of autism, at least partly because of Teresa's background as a biochemist. Janie has tried two different antidepressants. One failed because of side effects, but the second boosted her learning progress for a brief time, Teresa said. It was dropped, however, when that progress plateaued and side effects appeared. "We may try them again in the future,'' she said. "You just try things carefully,'' Mize said. "If they can tolerate it and make progress, you continue. If you don't make progress, you don't. "The treatment of autism is an area where the art of medicine is still very true. You have to do what you can to help the patients now.'' Staff writer David Rumbach:drumbach@sbtinfo.com(574) 235-6358